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Patient stories and case-studies

A district nurse chats with a patient

We care about your experiences

We want to share patients' experiences of our care to celebrate our staff and services who help local people and make a difference in the communities we serve. 

Click on the tabs below to watch films about our patient's stories, or read our patient case-studies:

Patient films

Find out more about our community nursing service in Hounslow and Richmond here.
A therapist from the Richmond Response & Rehabilitation Team with a patient

Case study 2:

Eighty-three year old Katharine Maskell needed care from the Richmond Response and Rehabilitation team after being discharged from hospital, where she’d spent two months recovering from an emergency operation.

Katharine explains: “I was referred to the team as I’d been in hospital so long that when I got out I couldn’t walk or use one of my arms. I needed to have continued physiotherapy and rehabilitation and I also needed some specialist equipment at home which I didn’t have, which the team arranged for me.”

The integrated team includes NHS physiotherapists and occupational therapists working alongside social workers from Richmond Council - a diverse range of healthcare professionals who provide seamless, coordinated care for vulnerable patients within the community.

Katharine has really benefited from the intense community rehabilitation provided by the team within her own home.

She says: “The physiotherapist and physio assistant came to see me three times a week because I needed two people’s support to stand up. They taught me to walk again, and made sure my recovery was made as easy as possible through the clearness of their instructions and by being on hand to help and point out where I was going wrong.”

Another unique feature of the team is the provision of a rapid response service - so that the most vulnerable patients in need of urgent help or advice are only a phone call away from accessing the right healthcare professional.

Katharine explains: “The team have always been there at the end of the phone when I needed them – if there’s been a problem I’ve always been able to call them for support. It’s been really useful to have one central number where I know I can access the care coordinator, the physiotherapists and the carers on that one line."

She talks glowingly about the team and the support they provided to her: “I would definitely recommend this service to friends and family. When I left hospital it was a worrying time and I didn’t quite know what was going to happen to me. The team have really helped me and now I feel much better and more settled. If anyone asked me how I got on with using this service, I’d say I did really well. Their general care and suggestions have really got me going again.”

Martine Freemantle, care coordinator and occupational therapist from the team has worked closely with Mrs Maskell from the outset. She said: “There has been a huge improvement in Katharine's condition since we have been working with her. From being unable to mobilise - to where she has got to now, the speed and totality of her recovery has been absolutely fantastic.”

Find out more:

You can find out more about the Richmond response and rehabilitation service here.

Patient stories and features:

Children's community nurses and kids

The trust’s children services successfully achieved a ‘good’ rating in 5/5 domains following the Care Quality Commission (CQC) inspection in March 2016.

The CQC found the trust’s children’s service to be safe, effective, responsive, caring and well-led and recognised the hard work of staff around delivering high quality end of life care services.

The Richmond children’s community nurse team, part of HRCH’s children’s services, helps local parents and carers of children with complex or palliative care needs – providing vital nursing care and support to enable parents and carers to manage their child’s condition at home.

Local patients Nerea and Eleanor met up with children’s nurses Sarah, Laura, Selina, Lara, Angeline and Claire after school recently to play some games, have a little food and drink and an intimate chat to see how the children were getting on.

Eleanor and Nerea, both currently at primary school, have been with the team since January 2015 after Eleanor was diagnosed with hypothalamic glioma, an inoperable type of brain tumour that left her blind, and Nerea was diagnosed with leukaemia.

Eleanor’s father Tim Stollery, who has been raising awareness through Twitter campaigns and the Houses of Parliament, said: “The children’s community nurse team have been nothing short of amazing and that’s genuine because the nurses’ attitudes and the way they are with Eleanor is just amazing.”

The children’s community nurses take Eleanor and Nerea’s blood, monitor their blood levels, provide support for their families, liaise with their primary and local treatment centres and offer support to their schools.

Claire Williams, children’s community nurse, said: “Nerea’s a really fun little girl and she’s been fantastic. The hard work and the length of visits you give them really pay off because Nerea’s got that trust in us now and we work with her to make sure she is mentally ready.

“We make a difference to the lives of all the children and families we see – and that is such a privileged position to be in.” 

For more information, visit www.hrch.nhs.uk/ccn-richmond or call the team on 020 3458 5275

Sara Dineen

Sara Dineen, who lives in Teddington, was brought into Kingston Hospital in February 2015 following a stroke - while also suffering from breast cancer that had spread to her spine.

Thanks to the staff at Richmond Rehabilitation Unit (RRU), Sara was discharged on 4 March and booked into an intensive six week strengthening sessions with a group of speech therapists, physiotherapists and occupational therapists as part of RRU’s early support discharge service for stroke patients. 

Sara was seen by the multidisciplinary team every day for the first two weeks and then three days a week for the remaining weeks in the team’s care. However the care didn’t stop there - the staff at RRU examined what was required in each room of her home and then implemented the right level of provision and equipment to help her regain her strength, mobility and confidence after the stroke.

Gareth, Sara’s husband and carer, said: “The whole thing was first class. The rehabilitation team makes you feel that you’re not on your own. The well-being of the patient is taken care of very quickly. It’s a very encouraging system and an extremely efficient service.”

Gareth continues, “There is continuity and that’s important. Because of this, they don’t spend 15 minutes reassessing. They can dive straight into it and are much more efficient with the care. You see the same person and consultant each time. It’s quicker and more intensive.”

The local rehabilitation team at Richmond Rehab Unit meet every Friday to discuss the patient’s planned timetable for the following week - involving the input of the entire multidisciplinary team.  Following a discussion amongst the various health professionals about Sara’s case - the team supplied Sara with a grip rail, a bath rail, a bath stool, a perching stool, a toilet frame, braces for her knees, and recommended her a wheelchair.  

Sara said: “I enjoyed doing all the things that the team asked me to do. If I was at home, I would just wake up and the day would be the same as any other day”.

Physiotherapist Lynsey Sharp, who has worked very closely with Sara since her stroke, said: “Sara has more mobility now than before she had the stroke. She has achieved all the goals we set and is now doing really well!”

The RRU is made up of a multi-disciplinary recovery team, a dietician and specialist nurses that focuses on rehabilitating stroke patients and those with motor-neuron diseases, Parkinson’s disease and traumatic head injuries.

Find out more:

You can find out more about our early supported discharge service for stroke patients here.

Physiotherapist Laura Room with patient Trevor King

When 76-year-old Mr Trevor King suffered a stroke, he was admitted to hospital where he spent six weeks as part of his initial recovery.

But instead of having to stay in hospital longer than was necessary, Mr King was assessed and discharged home into the care of the trust's early supported discharge service for stroke patients - so that he could continue his rehabilitation from home instead.

This innovative community service was setup to help Richmond patients who are medically ready to leave hospital get back into their own homes as quickly as possible, so they can receive rehabilitation and regain their former independence in familiar surroundings.

Mr King said: “I was having problems in hospital and felt very depressed. Following an occupational therapist survey of my house, I was told that I could go back home to receive treatment from an early supported discharge team.

“It was a great relief to get back home and out of hospital. Every single member of the team has been pleasant, caring and helpful. They have really urged me on – and that encouragement has been very important to me. I feel like everything has progressed since leaving hospital.”

He adds: “I didn’t realise how serious the stroke was and how badly affected my brain had been affected until much later on - however I am now on my way back to a normal life, although I’m not quite there yet. My balance is now much better than when I first came out of hospital, and I am much steadier on my feet thanks to the help of the team.”

The multidisciplinary stroke team consists of highly skilled community physiotherapists, occupational therapists, speech and language therapists and rehabilitation assistants - who work together to provide the intensive, coordinated care required by stroke patients as part of their rehabilitation.

Physiotherapist Laura Room, who has visited Mr King regularly at his home since his discharge from hospital said: “I find rehabilitating stroke patients in the community is very beneficial for people. We can work with patients’ in their homes, tailoring treatment around the context of their everyday lives. Patients are able to identify with why we’re doing what we’re doing - and the work we are doing becomes more relevant to each patient we see.”

“Generally patients are much happier while we’re working with them in their homes, as they’re around their loved ones and feel safe in their own environment which means they often engage better with the therapy. It also provides the opportunity for family members to become more involved in their care.”

Sue Newman, who manages the Trust’s neuro-rehabilitation services, said: “Recovering from a stroke can be very challenging and having the right care at the right time is vital to recovery.

“This local service for patients in Richmond provides expert help and supports people from the moment they get home, optimising recovery and assisting patients in regaining their independence.”

Find out more:

You can find out more about our early supported discharge service for stroke patients here.

family nurse partnership annual review 2016
Family nurse partnership annual review lunch held with staff and clients on 13 June 2016

Family nurse partnership welcomes clients to annual review informal lunch on 13 June 2016

Our Hounslow family nurse partnership (FNP) works with first time young mothers (from early pregnancy through to two years old) alongside midwives and replaces the health visiting service for these clients. The aim of FNP is to promote the health, well-being and self-sufficiency of first time young parents aged 19 and under. The programme uses in-depth methods to improve child development, child health, and help mums back into work.

FNP is a structured home visiting programme: every visit is planned with health, environmental or lifestyle help. General visiting is home-based and weekly, or in parks, cafes and children’s zones.

The team, made up of three family nurses and a supervisor, is currently supporting 60 families at the moment, are commissioned for up to 100 and provide guidance so that clients are the experts in their own lives.

The idea comes from America, from attachment theory, human ecology, self-efficacy and young parents get support to help themselves. It works on a change behaviour model where clients are getting support to change.

Local young mums and families met up with family nurses Louise and Kate and advisory board members for an informal chat over lunch for the annual review of the service at the Heart of Hounslow health centre. Jordan, a mum said: "I don’t know what I’d do without them. They provide help with everything: college, excursions, filling out forms."

Family nurse partnership young mums
Family nurse partnership supports young mothers

Supporting first-time young mothers

The family nurses provide intensive support from early pregnancy through to two years old. This evidence-based intervention works as children in the most vulnerable groups have been shown to be above development in this group, with up to date immunisations.

Natalie Douglas,  associate director for childrens services and operations lead for SWL, said: "The mums get intensive one-to-one time with a family nurse and without the service wouldn’t be able to get this support. The holistic approach gets families to improve with evidence based skills training and having a family nurse all the way through is making a difference."

Clare Mckenzie, commissioner at London Borough of Richmond upon Thames, said: “We help the most vulnerable mums by giving trusted advice to young mums, to help them give their children the best possible outcomes, it’s a commissioned service.”

Daisy Townson, family nurse supervisor at Heart of Hounslow, said: "Our motto is changing lives one baby at a time." FNP offers a unique programme of structured home visits delivered by specially trained ‘family nurses’. With this intensive model, the young mothers and families receive transformational support and evidence based approaches from early pregnancy until their child is two. The aim of FNP is to improve the health and wellbeing of Hounslow's most disadvantaged families and children, while improving parenting skills and reducing the problems associated with social exclusion.

Find out more:

You can find out more about our family nurse partnership service for young mothers here

Ernerst - a successful ex-smoker

Stop smoking interview with Ernest Deacon

Local resident Ernest Deacon first attended one of the trust's local stop smoking service’s drop-in clinics in February 2013. Thanks to the support that the team provided, combined with Ernest's determination to quit, he has now successfully been smoke-free for over 18 months.

The trust’s stop smoking service office manager, Mike Carveth, caught up with Ernest recently to hear about his experience with the trust’s stop smoking service, the financial and health benefits of giving up - and why Ernest feels he will never smoke again:

Mike: Congratulations on managing to stop smoking! How would you describe your experience of stopping with Hounslow Stop Smoking Service?

Ernest: Excellent! I heard about it as I picked up a flyer from Heart of Hounslow. I found myself badly out of breath as I left the health centre that day - this was on a Monday, and come Tuesday morning I was in one of the team’s stop smoking drop-in clinics!

Mike: Which medication did you use to help you stop?

Ernest: An inhalator. I’ve always been a very light user of them as they say you can have up to 6 a day, but I’ve only ever used one or two!

Mike: What has been the hardest thing whilst trying to give up?

Ernest: I would say certain times of the day, which I think many smokers would relate to. The most difficult times were first thing in the morning and after lunch and dinner.

Mike: What motivated you to stop smoking?

Ernest: I collapsed 3 times due to my COPD as my chest felt very tight. After the third time this happened decided it was time to do something about my smoking habit.

Mike: Have you tried to stop before?

Ernest: Oh yes! I would say I have tried over 24 times! The longest I ever stopped for before now was for 3 months.

Mike: What made it easier this time?

Ernest: The fact that I was so determined after having collapsed and also the inhalator.

Mike: What have you been spending the money you’ve saved from not smoking on?

Ernest: I went to Glasgow for Christmas last year and I now have money to go out and socialise more with friends. I opened a savings account I called my ‘Baccy Account’ and when I first stopped I was putting in £50 a week that I otherwise would have spent on cigarettes.

Mike: Do you feel healthier? What changes have you noticed whilst stopping?

Ernest: Oh yes! I’m feeling a lot better now in myself now! My lungs feel much better and I can walk much further than before.

Mike: Are you telling friends and other members of your family about the service?

Ernest: Yes, absolutely. I tell them about the drop-in clinics at Feltham Centre for Health Heart of Hounslow Centre for Health

Mike: Would you recommend the service to other people?

Ernest: Yes and I do! Quite regularly in fact!

Mike: How has quitting changed your life? What message would you have for others that want to quit?

Ernest: I would say to people that it will greatly improve your breathing and will be able to walk further without getting breathless. My message would be that it definitely is possible to stop and you will feel a lot healthier when you do.

Mike: Are you confident that you will now be able to stay smokefree?

Ernest: Yes! It’s been 18 months now and I’m still going strong!


Find out more:

You can find out more about our stop smoking service in Hounslow here

Lilie and Jess
Lilie and Jess

Lilie Hudson, who has lived in Feltham all her life, had been smoking for 55 years. Thanks to the support that HRCH’s stop-smoking team provided at previous outreach events, combined with her determination to quit, Lilie has now successfully been smoke-free for over 12 weeks. 

Lilie started smoking at aged 16 when she left school at 15 to work at a factory on Green Lane. 

Lilie said: "Everyone during their tea break would go outside and have a cigarette and a cup of tea. Everybody smoked then. 

She said: "The encouragement to stop wasn't really there. You would just stop a few days before an operation so you can take the anaesthetics better and once you finished you'd just go down to the smoking room. I'd have drips and drains in and a blanket over me"

Lilie set herself a quit-date of 23 November 2015 and attended HRCH’s local stop smoking service’s drop-in clinics on a weekly basis after she spoke with stop smoking advisor Jessica Cox at one of the team’s local outreach events at Tesco, High Street Feltham on 16 October.

Jess offered Lilie care and support that was individually tailored to her needs. She provided her with Champix - medication which blocks the nicotine receptors - and weekly face-to-face drop-in sessions where she could talk and help her through any challenges that she may have stop smoking. 

Lilie said: “I couldn't have done it on my own without the tablets and Jess' help. What really made a difference was coming in and talking to Jess and the encouragement that she gave me. It's the personal support that you're getting that made the difference. I always looked forward to coming here on Thursday morning!"

She said: "I have tried other things such as patches but they didn't work for me. Jess explained everything on our first meeting and recommended that I went onto the tablets. There’s not judgement with Jess, just encouragement.”

Jess said: "I wish I had that when I gave up smoking. It's hard to explain addiction to someone who's never been addicted to something. 

She said: “It’s hard to explain the hunger to put something in your mouth and light it and the chemical addiction that comes with it. That's why I do this job and why I enjoy it so much."

Lilie looks forward to her son's new baby that will be born in a few months, but knew she would have to quit smoking if she wanted to look after the baby in her own home. 

Lilie said: "The baby was the biggest motivation for me to give up. I know he wasn't going to bring the new baby into the house with smoke in it." 

Local people in Hounslow can self-refer themselves to the stop smoking service for help and support from the team - so please call us on 020 8630 3255 or email stop.smoking@hrch.nhs.uk and a stop smoking advisor will get back to you as soon as possible.  

Find out more:

You can find out more about our stop smoking service in Hounslow here

One of our dietitians with a patient

Weigh2Lose: preventing illness, improving health & wellbeing

“It really has changed my life,” says 46-year-old management development trainer Kay Wren, who has lost 11kg on our Weigh2Lose programme.

Kay had been overweight for most of her life, when a flyer was dropped through her door in January 2012 advertising Weigh2Lose, our 12-week healthy eating and exercise programme.

Run by dietitian Alex Russell, the course was being provided five minutes away from her home on the Sparrow Farm Estate in Feltham. Kay decided to join:

“I wanted to lose weight and I also thought it would be a good opportunity to meet other people in the area as well,” she says.

As an added complication, a week after she joined the programme, she found out she had type 2 diabetes.

“I had my annual blood test with my GP and I was shocked to find out I had diabetes and hypertension. I had already taken the first step by signing up to the programme but the diagnosis was the added impetus I needed to really take my health seriously,” she says.

Kay signed up for the programme in January 2012 along with 13 others from the Sparrow Farm Estate. The trust joined forces with Hounslow Homes and the Sparrow Farm Estate Residents’ Association to deliver the 12-week course.

Weigh2Lose is a 12-week weight management, healthy lifestyle and exercise group run by dietitians, nutritionists and physical activity instructors. It is run by our Health Promotion Team at venues across Hounslow.

Kay lost 11kg on the programme and credits dietitian Alex with her success:

“Alex was superb. She always had time to talk on a one to one basis. I learned an awful lot from her. She helped enormously with breaking my patterns of behaviour that were making me over eat,” she says.

One of the things Kay found most useful was learning about food labelling.

“I now go around the supermarket and I won’t buy anything without looking at the label first. I always look for lighter choices now.”

Another benefit was the group aspect of the course.

“If I didn’t have the programme, I wouldn’t have had the support of the other people in the group who were also going through the same thing as me. I wanted to do well for them as much as for myself,” she says.

The course was also useful for signposting Kay to other services run by the local NHS and Hounslow Council.

“It really opened my eyes to what’s available in the borough. I began going on Hounslow Health Walks every Wednesday, and we’ve decided to start our own walking group with others from Sparrow Farm. I’ve also joined the gym – something I wouldn’t have done if it wasn’t for the programme. It really has changed my life,” she says.

Find out more:

You can find out more about our Weigh2Lose programme here.

A member of our Children's Asthma Team working with a patient

Supporting and enabling those with long-term conditions to remain as healthy and independent as possible, for as long as possible, in their home or community.

“We now have a lot more control over Morgan’s asthma. She’s happier and healthier and more independent. I feel more confident that I can manage her condition at home, and so does Morgan,” says Claire Oakley whose daughter Morgan has been part of the trust’s Wheezy Kids programme.

Morgan, aged nine, suffers from brittle asthma and was regularly attending A&E at West Middlesex Hospital with breathing difficulties up to two years ago. But thanks to our specialist asthma nurse Sanjeev Beharee, she now very rarely goes to A&E.

Sanjeev visited Morgan and Claire at home and gave them advice about using her inhaler correctly, and also drew up a self-management plan for Morgan which they also shared with her school.

“The care plan has been fantastic. Everything we need to do to manage Morgan’s asthma is written down in an easy to understand way. I used to be called almost every day by the school but now they never call,” says Claire.

“We haven’t been to A&E in the last six months. A few years ago, I wouldn’t have considered that possible,” she laughs. Hounslow has a particular problem with asthma, with 2700 children going to A&E each year with a wheezy chest.

The wheezy kids service was initially piloted in Feltham and resulted in a twenty per cent drop in A&E admissions for wheeze in 2010. As a result of its success it was rolled out across the borough in 2011.

Sanjeev and his team work with West Middlesex Hospital to identify children who have been admitted to A&E for asthma-related issues. They then contact the family and offer to visit them at home to help educate them to manage their condition.

He says, “We work with the child, their family and hospital and community services to put in place a specific self-management plan to help them manage their condition. Knowing what triggers the onset of asthma and knowing what to do immediately when it starts, is the key to successfully managing this condition.”

Claire Oakley says, “The fact children are seen in their home environment is important as the nurse can see their symptoms at home and look at things from a holistic perspective. Morgan now knows how to control her asthma and so do I.”

Sanjeev and his team are also available to phone or email if a parent has any questions.

“Sometimes I’ve called Sanjeev for advice as I wasn’t sure what to do. It is an absolutely fantastic service. I wish we’d had it earlier."

Find out more:

You can find out more about our children's community asthma and wheeze service in Hounslow here.

A community matron treats a patient

“I know I’d be in hospital if it wasn’t for Maggie. She’s just brilliant”, says 65-year-old Heather Porter, about Community Matron Maggie Clark who is part of the Community intravenous (IV) Therapy Service.

Mrs Porter, from Feltham, developed an infection in her wound following surgery and was prescribed intravenous antibiotics.

But instead of having to stay in hospital, she was discharged and referred to our IV Therapy Service, delivered by the trust’s community nurses who administer the antibiotics in Mrs Porter’s home.

Emma Nikolajenko, Community IV Therapy Clinical Nurse Specialist and Service Facilitator, says: “The service is designed to not only reduce the length of time patients have to stay in hospital but to prevent unnecessary admissions to hospital. Many of our community nurses are now trained to be able to administer medications intravenously and can also cannulate the patient if required, which means that patients who previously would have had to stay in hospital to be treated, can now be treated at home.”

“We have seen an increase in the number of the referrals over the last 12 months with a large percentage of patients requiring once a day antibiotics for up to seven days. We are also starting to receive more referrals for chemotherapy patients too for maintenance flushes of their IV device in between their visits to the hospital for their chemotherapy. GPs are also starting to refer patients to the service to avoid unnecessary admissions to hospital”.

“The service can usually see patients for once or twice a day visits, short or long term durations of treatment, 365 days a year."

Mrs Porter adds, “Maggie or another nurse from her team come four times a day to administer my medication. They’re brilliant. They’re friendly, helpful and professional.”

One of our community matrons visiting a patient

Supporting patients and their families by providing high quality integrated end of life care, enabling people to die in their place of choice.

"My dad’s great wish was to die at home. This was the part of his life that I cannot stress enough how greatly valued the community nursing team were to us. The care and planning that was put in place for him ensured that he had a dignified and peaceful death." says Sue Southon whose father Ken passed away, aged 85, in August 2011.

“He was not an easy man,” she laughs. “But because Lesley and the team had known him for some time, they knew how to communicate with him, and knew how to approach those difficult questions with him.”

The Lesley she’s referring to is Lesley Simmons, one of our community matrons based in Sheen in Richmond. Lesley was assigned to Sue’s father Ken Ackary, several years before he passed away when he was diagnosed with Chronic Obstructive Pulmonary Disease (COPD).

“Lesley established a relaxed rapport with him. He grew to trust her. She gradually introduced other clinicians to help him with the COPD such as the physiotherapist, the respiratory nurse, the speech and language therapist and so forth,” says Sue.

“When it became clear he wasn’t going to get better, he went into hospital twice, and when he was discharged, Lesley arranged a package of care so that he could die comfortably at home,” says Sue.

“The best thing about Lesley and all the nurses is that they always took a holistic approach. They always asked how I was and how my mum was. They weren’t just concerned with Dad’s health but the impact on the wider family’s welfare as well,” says Sue.

One of the major roles of our community matrons is co-ordinating and providing end of life care for patients in their homes.

One such project that has been implemenetd in Richmond to improve the quality of end of life care in the borough is called Coordinate my Care:

Coordinate My Care

Coordinate My Care is a way of electronically storing information about patient’s illness and any specific wishes. Coordinate My Care gives patients an opportunity to make decisions and express their views and wishes about their medical care.

Lesley says, “Co-ordinate My Care is relatively new. The overriding aim of the electronic record is to improve clarification and communication of information between healthcare providers in all settings for end of life care patients’ to enable patient preferences to be achieved and avoid unnecessary hospital admissions.”

Find out more

You can find out more about our community matrons service across Hounslow and Richmond here.

Must read! This is a book that patient Jonathan Gantley wrote to share his experiences of all the NHS services that helped him.

Patient book Jonathan Gantley  Home Tales Jonathan Gantley